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General NPI Number Information
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NPI Number | 1053774596
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Entity Type | Organization
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Legal Business Name | SOLE PODIATRY CENTER PA
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 5475 GOLDEN GATE PKWY STE 4
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City | NAPLES
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State | FL
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Zip | 34116-7529
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Country | US
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Telephone | 239-353-1555
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Fax | 239-353-7001
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Provider Business Mailing Address
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Address Line | 5475 GOLDEN GATE PKWY STE 4
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City | NAPLES
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State | FL
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Zip | 34116-7529
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Country | US
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Telephone | 239-353-1555
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Fax | 239-353-7001
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SEAN M. KIBRIA
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Credential | D.P.M.
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Telephone | 239-353-1555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | P03769
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License Number State | FL
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